Healthcare Provider Details

I. General information

NPI: 1821473760
Provider Name (Legal Business Name): PLASTIC SURGERY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MCLAWS CIR
WILLIAMSBURG VA
23185-5650
US

IV. Provider business mailing address

260 MCLAWS CIR
WILLIAMSBURG VA
23185-5650
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-5599
  • Fax: 757-345-5516
Mailing address:
  • Phone: 757-345-5599
  • Fax: 757-345-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0101840454
License Number StateVA

VIII. Authorized Official

Name: DR. ROGER E EMORY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-345-5599